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Practice Guideline
. 2024 Dec;271(12):7387-7401.
doi: 10.1007/s00415-024-12502-1. Epub 2024 Jul 4.

Systematic review-based guideline "Parkinson's disease" of the German Society of Neurology: diagnostic use of transcranial sonography

Uwe Walter  1   2   3 , Kai F Loewenbrück  4   5 , Richard Dodel  6 , Alexander Storch  7   8   9 , Claudia Trenkwalder  10   11 , Günter Höglinger  12   13   14 ; German Parkinson Guideline Group
Affiliations
Practice Guideline

Systematic review-based guideline "Parkinson's disease" of the German Society of Neurology: diagnostic use of transcranial sonography

Uwe Walter et al. J Neurol. 2024 Dec.

Abstract

Background and objective: Transcranial brain parenchyma sonography (TCS) has been recommended as a tool for the early and differential diagnosis of Parkinson's disease (PD) in German and European clinical guidelines. Still, the brain structures to be examined for the diagnostic questions and the requirements for being a qualified investigator were not specified in detail. These issues have now been addressed in the 2023 update of the clinical guideline on PD by the German Society of Neurology (DGN).

Methods: The recommendations were based on a systematic literature review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

Results: Three diagnostic questions were defined: (1) What is the accuracy of TCS in the differential diagnosis of PD versus atypical and secondary Parkinsonian syndromes? (2) What is the accuracy of TCS in the differential diagnosis of PD versus essential tremor? (3) What is the accuracy of TCS in the diagnosis of PD in persons with typical early symptoms, compared with the diagnosis established by clinical follow-up? The brain structures to be assessed and the level of recommendation were formulated for these questions. The training requirements for being regarded as qualified TCS investigator were stipulated by the responsible medical societies (German Society of Ultrasound in Medicine, DEGUM; German Society for Clinical Neurophysiology and Functional Imaging, DGKN). Finally, the recommendations for these diagnostic questions reached strong consensus (each ≥ 97%) of the guideline committee. Here, the details of review and recommendations are presented.

Conclusion: The updated guideline clarifies the diagnostic uses and limitations of TCS in PD.

Keywords: Essential tremor; Neuroimaging; Parkinsonism; Parkinson’s disease; Systematic review; Transcranial ultrasound.

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Conflict of interest statement

Declarations. Conflicts of interest: U.W. has received speaker honoraria and travel grants from Bristol-Myers Squibb, Boehringer Ingelheim Pharma, Daiichi-Sankyo, Ipsen Pharma, Merz Pharmaceuticals, Pfizer Pharma, and an unrestricted research grant from Merz Pharmaceuticals outside the present study. He was funded by the German Federal Ministry of Education and Research (BMBF) outside the present study. He serves as Joint Editor-in-Chief of the European Journal of Ultrasound (Thieme, Stuttgart, Germany). K.L. has stated explicitly that there are no conflicts of interest in connection with this article. R.D. received research support from DGN, Faber-Stiftung Marburg, General Electric, LINF, and Roche. He serves as a consultant for Lilly. He received honoraria for scientific presentations from Eisai, Lilly, Roche and others but all honoraria were used for research (except travel costs). He is an investigator on three patents hold by the Philipps-University Marburg, Germany. A.S. has received funding from the Deutsche Forschungsgemeinschaft (German Research Association) and the Helmholtz-Association outside the present study. He has received honoraria for presentations/advisory boards/consultations from Esteve, Desitin, Lobsor Pharmaceuticals, STADA, Bial, RG Gesellschaft, Zambon, NovoNordisk and AbbVie outside the present study. He has received royalties from Kohlhammer Verlag and Elsevier Press. He serves as an editorial board member of Stem Cells International. C.T. has received funding from the DLR (German Research Association) by ERA-Net Project BRAVA (EU-Grant) outside the present study. She has received honoraria for presentations/advisory boards/consultations from Abbvie, UCB, STADA, Bial, Roche, Boehringer Ingelheim Pharma, Convatec, Ono Pharmaceuticals outside the present study. She has received royalties from Thieme Publisher and licence Fees for Parkinson Sleep Scale. She has received travel stipends from the Movement Disorder Society. She serves as an editorial board member for Sleep Medicine. G.H. received research support from Abbvie, UCB; has ongoing research collaborations with Roche, UCB, Abbvie; serves as a consultant for Abbvie, Alzprotect, Amylyx, Aprinoia, Asceneuron, Bayer, Bial, Biogen, Biohaven, Epidarex, Ferrer, Kyowa Kirin, Lundbeck, Novartis, Retrotope, Roche, Sanofi, Servier, Takeda, Teva, UCB; received honoraria for scientific presentations from Abbvie, Bayer, Bial, Biogen, Bristol Myers Squibb, Kyowa Kirin, Pfizer, Roche, Teva, UCB, Zambon. He holds a patent (Höglinger GU, Höllerhage M, Rösler T. Treatment of Synucleinopathies. United States Patent No.: US 10,918,628 B2, Date of Patent: Feb. 16, 2021; and European Patent No.: EP 17 787 904.6–1109 / 3 525 788). He received publication royalties from Academic Press, Kohlhammer, and Thieme. He was funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Germany’s Excellence Strategy within the framework of the Munich Cluster for Systems Neurology (EXC 2145 SyNergy – ID 390857198); the German Federal Ministry of Education and Research (BMBF, CurePML EN2021-039); European Joint Programme on Rare Diseases (Improve-PSP); Deutsche Forschungsgemeinschaft (DFG, HO2402/18–1 MSAomics); and participated in industry-sponsored research projects from Abbvie, Biogen, Biohaven, Novartis, Roche, Sanofi, UCB.

Figures

Fig. 1
Fig. 1
Transcranial sonography (TCS) in the diagnosis of Parkinson’s disease (PD). A MRI of midbrain axial transection corresponding to the TCS images shown in (B) and (C). B Axial TCS scan at midbrain level in an individual with normal aspect of substantia nigra (small echogenic area, SN–). This finding is typical for essential tremor and multiple system atrophy. C Axial TCS scan at midbrain level in an individual with enlarged echogenic size of substantia nigra (hyperechogenicity, SN +). This finding is typical for PD. D Position of the ultrasound transducer for diagnostic TCS in PD. E Zoomed TCS image of midbrain shown in (B). The echoic area of substantia nigra is traced for automated measurement. F Zoomed TCS image of midbrain shown in (C). The echoic area of substantia nigra is traced for automated measurement. G MRI of basal-ganglia axial transection corresponding to the TCS images shown in (H) and (I). C caudate nucleus, L lenticular nucleus, T thalamus, arrow head: pineal gland. H Axial TCS scan at basal-ganglia level in an individual with normal aspect of lenticular nucleus (weakly echogenic, LN−; arrow). This finding is typical for PD. I Axial TCS scan at basal-ganglia level in an individual with increased echogenicity of lenticular nucleus (LN + ; arrow). This finding is frequent in atypical Parkinsonian syndromes
See this image and copyright information in PMC

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